Provider Demographics
NPI:1992465348
Name:POLLOCK, CODY
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1469
Mailing Address - Country:US
Mailing Address - Phone:740-490-8674
Mailing Address - Fax:
Practice Address - Street 1:112 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1469
Practice Address - Country:US
Practice Address - Phone:740-490-8674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker